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PANCE Cardiology Actual Exam |
Questions and Verified Correct
Answers| Latest Version 2026-
2027| 100%Score.
What is the definition of cardiomyopathy? Heart disease resulting from a primary abnormality in the myocardium List two types of surgical procedures to correct hypertrophic obstructive cardiomyopathy
- Open heart and excision
- Alcohol ablation done through cardiac catheterization What heart sound will likely be present with hypertrophic obstructive cardiomyopathy? S List three medications that may be used both to prevent arrhythmia and ease symptoms with hypertrophic obstructive cardiomyopathy
- Diuretics 2 Beta-blockers
- Non-dihydropyridine CCB (verapamil or diltiazem)
Once a patient is diagnosed with hypertrophic obstructive cardiomyopathy what family counseling must be done? Entire family must be screened for HOCM Angina, syncope, and heart failure in a child likely represents ____________. HOCM (Hypertrophic Cardiomyopathy) What causes the sudden cardiac death in a patient with hypertrophic obstructive cardiomyopathy? Ventricular tachycardia that degenerates into ventricular fibrillation What maneuver makes the hypertrophic obstructive cardiomyopathy murmur louder? Valsalva or standing What are the signs of hypertrophic obstructive cardiomyopathy on the exam?
less than 40% (in the presence of increased left ventricular dimension) What do low ejection fraction and hypertrophic (HOCM) heart have in common? Sudden death due to VT Which chamber is most affected in cardiomyopathies? Left ventricle What chambers are affected (and how) in dilated cardiomyopathy? Enlargement and dilation of all four chambers What is the most common cause of non-ischemic dilated cardiomyopathy in the US? Chronic alcoholism What is the second most common cause of non-ischemic cardiomyopathies? (#1 in other parts of the world)
Viral myocarditis What is damaged in dilated cardiomyopathy and what does it result in? Myocytes are injured and necrosis occurs with myocardial fibrosis - when muscle cells fail they dilate Does dilated cardiomyopathy have a systolic or diastolic dysfunction? Systolic dysfunction What is the number one cause of dilated cardiomyopathy overall? Ischemic cardiomyopathy (more than 60% of patients with heart failure have this) What is seen histologically in dilated cardiomyopathy? Nonspecific abnormalities, variations in myocyte size, myocyte vacuolization, fibrosis, and fat replace myocardium How does alcoholism lead to dilated cardiomyopathy?
Hypertrophy of myocardial fibers and interstitial fibrosis Where is the mutation that leads to hypertrophic cardiomyopathy located? Any one of several genes that encode proteins within the sarcomere What is seen on an echocardiogram for hypertrophic cardiomyopathy? Hypertrophic septum and LV wall along with decreased ejection fraction What happens to the myocardium in restrictive cardiomyopathy? The myocardium is infiltrated with abnormal tissue- leading to impaired ventricular wall motion and abnormal contraction and relaxation What population is most susceptible to restrictive cardiomyopathy? Men of northern European descent List 6 causes of restrictive cardiomyopathy. Amyloidosis - Hemochromatosis - Sarcoidosis - Scleroderma - Fibrosis - Cancer
Sinus tachycardia is a normal sinus rhythm but with a heart rate over ________ bpm 100 bpm Sinus bradycardia is a normal sinus rhythm with a rate of _________ bpm < 60 bpm EKG: no discrete P waves and an irregularly irregular pattern of QRS complexes. What's the dx? Atrial Fibrillation EKG: Regular, sawtooth pattern (F-waves), narrow QRS complex. What's the dx? Atrial Flutter EKG: PR interval > .2 seconds. What's the dx? First degree AV block EKG: Progressive prolongation of the PR interval culminating in a non-conducted P wave. What's the dx? Mobitz I Wenckebach block (longer, longer, drop now you've got a Wenckebach)
Wolff-Parkinson-White Syndrome EKG: Rapid irregular rhythm > 100 bpm. At least 3 distinct P-wave morphologies. What's the dx? Multifocal Atrial Tachycardia EKG: An abnormal (non-sinus) P wave is followed by a QRS complex. What's the dx? Premature Atrial Complex (PAC) EKG: Narrow QRS complex, either (1) without a preceding P wave or (2) preceded by an abnormal P wave with a PR interval of < 120 ms. What's the dx? Premature Junctional Complex (PJC) Broad QRS complex (≥ 120 ms) with abnormal morphology. What's the dx? Premature ventricular contractions (PVC) Every 3rd beat is a PVC Trigeminy Every other beat is a PVC Bigeminy
EKG: Alternating bradycardia with paroxysmal tachycardia, often supraventricular in origin. What's the dx? Sinus Node Dysfunction (Sick Sinus Syndrome)Bradycardia-tachycardia syndrome EKG: Broad complex tachycardia originating in the ventricles. What's the dx? Ventricular Tachycardia (VT) EKG: Chaotic irregular deflections of varying amplitude No identifiable P waves, QRS complexes, or T waves. What's the dx? Ventricular Fibrillation EKG: Polymorphic ventricular tachycardia that appears to be twisting around a baseline. What's the dx? Torsades de Pointes (TdP) EKG: Vertical spikes of short duration, usually 2 ms. May be difficult to see in all leads Pacemaker Rhythm with *pacing spikes" Prolonged absence of sinus node activity (absent P waves) < 3 seconds Sinus pause
What two murmurs are most associated with atrial fibrillation? Mitral stenosis - Mitral regurgitation What HTN med classes can cause bradycardia? Beta Blockers - Central agents (clonidine) - Verapamil and Cardizem What arrhythmia is associated with arterial embolism? Atrial fibrillation A 24-year-old has a syncopal event. EKG demonstrates a short PR interval with an upswept initial QRS. What underlying condition caused the syncope? Wolf Parkinson White A 30-year-old male has a syncopal event three days after taking an antibiotic. EKG at the scene reveals ventricular tachycardia. What disease condition do you suspect? Acquired long QT syndrome due to the antibiotic or medications Upon auscultation of a patient's carotid artery they become bradycardic with a three second pause. What is the suspected underlying condition? Carotid sinus hypersensitivity
A 13-year-old boy passes out while having an argument with his principal. His examination findings are normal. What heart conduction condition do you suspect? Long QT syndrome What is Atrial fibrillation (A-fib)? Atrial fibrillation (A-fib) is an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart. What is the most common risk factor for atrial fibrillation? Hypertension is the most common risk factor for atrial fibrillation. Atrial fibrillation is the most commonly encountered cardiac arrhythmia. What are thy symptoms of A-fib? Symptoms include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope What is seen on an ECG tracing of atrial fibrillation?
The ectopic impulses causing atrial fibrillation most commonly originates from the roots of the pulmonary veins How is the atrial fibrillation rhythm typically described? The atrial fibrillation rhythm is described as irregularly irregular How is paroxysmal atrial fibrillation defined? Paroxysmal atrial fibrillation is defined as intermittent attacks that resolve spontaneously in less than seven days How is persistent atrial fibrillation defined? Persistent atrial fibrillation is defined as atrial fibrillation rhythm that lasts more than seven days Rate control strategy of managing atrial fibrillation aims to keep the heart rate below what rate?
Rate control strategy of managing atrial fibrillation aims to keep the heart rate below 110 beats per minute What is the scoring system to assess the risk of stroke in patients with Afib? Anticoagulation is determined by CHA2DS2-VASc or CHADS2 scoring to assess the risk of stroke What does CHA2DS2-VASc stand for? CHA2DS2-VASc: C-Chronic Heart Failure-1 point H-Hypertension-1 point A-Age <64-0 point : 64- 75 - 1 point : >75-2 points D-Diabetes Mellitus-1 point S-Stroke/TIA-2 points VA-Vascular disease-1 point
1 point – either 81–325 mg/day of aspirin or anticoagulation 2 or more points – anticoagulation When indicated, what class of medication is preferable in patients with atrial fibrillation? Direct oral anticoagulants or DOAC (eg, dabigatran, rivaroxaban, apixaban, or edoxaban) rather than warfarin for most patients in whom oral anticoagulant therapy is chosen What are some instances warfarin should be chosen over DOACs in patients with Afib.? Warfarin is preferable to DOACs in patients with mechanical heart valves, mitral stenosis, unacceptable increase in cost, EGFR < 30 ml/min, on certain medications (ex. phenytoin or certain antiretroviral therapy) What is atrial flutter? Atrial flutter is similar to atrial fibrillation, a common disorder that causes the heart to beat in abnormal patterns due to a large atrial reentrant circuit
What are the symptoms of atrial flutter? Symptoms a atrial flutter are the same as A-fib and include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope Diagnosis of atrial flutter? The diagnosis of atrial flutter is by ECG. In typical flutter, ECG shows continuous and regular atrial activation with a sawtooth pattern, most obvious in leads II, III, and aVF Treatment of atrial flutter? Treatment of atrial flutter is the same as that for A-fib and focuses on ventricular rate control, rhythm control, and prevention of thromboembolism. What is atrioventricular block? Heart block, also called Atrioventricular (AV) block is partial or complete interruption of impulse transmission from the atria to the ventricles
